Healthcare Provider Details

I. General information

NPI: 1376377911
Provider Name (Legal Business Name): HALEY PUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 PONCE DE LEON BLVD STE 26
CORAL GABLES FL
33146-2435
US

IV. Provider business mailing address

470 NE 5TH AVE APT 3427
FORT LAUDERDALE FL
33301-2502
US

V. Phone/Fax

Practice location:
  • Phone: 786-664-7810
  • Fax:
Mailing address:
  • Phone: 319-493-0200
  • Fax: 305-340-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11034959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: